Healthcare Provider Details

I. General information

NPI: 1245590330
Provider Name (Legal Business Name): STACY LAUREN WEINBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PFINGSTEN RD STE 3000
GLENVIEW IL
60026-1314
US

IV. Provider business mailing address

2150 PFINGSTEN RD STE 3000
GLENVIEW IL
60026-1314
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2503
  • Fax: 847-657-3531
Mailing address:
  • Phone: 847-570-2503
  • Fax: 847-657-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137653
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036137653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: